A Dose-effect Study Of Transverse Abdominis Plane Block On Postoperative Analgesia In Patients With Hysteromyomectomy

Objective:To explore the difference of postoperative analgesic efficacy after laparoscopic myomectomy by ultrasound-guided transverse abdominis plane block(TAP)using different doses of Ropivacaine.Methods:Select 120 cases of patients from the second hospital of shanxi medical university in January 2019 to October 2019,undergoing laparoscopic myomectomy after general anesthesia,aged 30 to 60 years old,BMI in 19-25 kg/m2,ASA ? or ? level and divide them randomly into A1,A2,A3,B1,B2,B3,a total of 6 groups.Group A1 : 2 mg/kg ropivacaine diluted to 30 ml;Group A2:2mg/kg ropivacaine diluted to 40ml;Group A3:2mg/kg ropivacaine diluted to 50ml;B1:3mg/kg ropivacaine diluted to 30ml;B2:3mg/kg ropivacaine diluted to 40ml;B3: dilute 3mg/kg ropivacaine diluted to 50 ml.Each group was blocked by bilateral TAP under ultrasound guidance before anesthesia,and the local anesthetic dosage was 1/2 on each side.PCIA was performed in both groups.After operation,the pain relief pump was adjusted according to the degree of pain of the patients.VAS score was 0-3,the pain relief pump would be turned off,and the pain relief pump would be turned on after 3 points.VAS scores and Ramsay sedation scores were performed at the time of leaving the PACU and at 2,6,12 and 24 h after the operation.The opening time of pain relief pump and the number of patients who applied pain relief were recorded.The occurrence of adverse reactions was recorded.Results:Compared with the A1 and A2 groups,VAS scores at 2,6 and 12 h after operation in the A3 group were significantly reduced,with statistically significant differences.Similarly,compared with B1 and B2 groups,VAS scores of B3 groups at 2,6 and 12 after surgery were significantly reduced,with statistically significant differences.There were no statistically significant differences in VAS scores,analgesic recovery rate and analgesic pump opening time between groups A1 and B1,A2 and B2,A3 and B3.There was no statistically significant difference in the incidence of nausea and vomiting among the six groups.No adverse reactions such as pruritus and chest tightness were observed in the six groups.No adverse reactions related to TAP block,such as hematoma and infection,were found.Conclusion:The postoperative analgesic effect of 50 ml ropivacaine at 2mg/kg under bilateral ultrasound-guided TAP blockade is better for patients with laparoscopic myomectomy.